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General NPI Number Information
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NPI Number | 1558065920
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Entity Type | Individual
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Provider Name | TIFFANY GIBSON ALS
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 903 E TOWNE LAKE CIR
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City | OPELIKA
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State | AL
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Zip | 36804-3207
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Country | US
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Telephone | 334-444-5869
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Fax |
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Provider Business Mailing Address
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Address Line | 903 E TOWNE LAKE CIR
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City | OPELIKA
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State | AL
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Zip | 36804-3207
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Country | US
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Telephone | 334-524-7897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | ALC04441
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License Number State | AL
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